Compressing the Zones of Care

The Hartford Consensus recommends that an integrated active shooter response should include the critical actions contained in the acronym THREAT:

Threat suppression

Hemorrhage control

Rapid Extrication to safety

Assessment by medical providers

Transport to definitive care

A key component of the Hartford Consensus is this:

In the immediate aftermath of a mass casualty event, some lives may be lost through caution. The standard approach has been to cordon off the zone of casualties, a wide “hot zone,” until it’s been ensured that all threats are suppressed. The Hartford Consensus suggested that the plan be modified to allow earlier access to victims outside the real hot zone, the location of the active shooter, or a possible bomb. Thus, agreement on new systems of integration and coordination between law enforcement and other teams of responders is needed to ensure the mutual understanding and sequencing of roles.*

By compressing the “hot zone” with the two other zones of care, the “warm zone” and the “cold zone,” less time is lost and more time is made available to begin bleeding control techniques so that more lives are saved (see diagram below).

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The 'Stop the Bleed' campaign was initiated by a federal interagency workgroup convened by the National Security Council Staff, The White House. The purpose of the campaign is to build national resilience by better preparing the public to save lives by raising awareness of basic actions to stop life threatening bleeding following everyday emergencies and man-made and natural disasters. Advances made by military medicine and research in hemorrhage control during the wars in Afghanistan and Iraq have informed the work of this initiative which exemplifies translation of knowledge back to the homeland to the benefit of the general public. The Department of the Defense owns the 'Stop the Bleed' logo and phrase – trademark pending.